Not Just Cutting It—A Successful Interprofessional Cooperation Between Palliative Care, Pain and Neurosurgery in the Treatment of Intractable Cancer Pain (TH337)

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•List three neurosurgical procedures that selectively intervene along the pain processing pathways and to describe their role in the treatment of intractable cancer pain.•Perform case analysis of different clinical cases of patients with intractable cancer pain and to appropriately make an interdisciplinary based patient selection for different neurosurgical procedures. There is a great importance to deliver good pain management to cancer patients suffering from advanced metastatic disease. Unfortunately, there are selected patients for whom pharmacotherapy does not achieve acceptable pain relief or is limited by marked side effects. These patients, may benefit from neurosurgical procedures that selectively intervene along the pain processing pathways. Patients with localized pain can benefit from selective percutaneous cordotomy, while patients who suffer from diffuse pain due to widespread disease are candidates for stereotactic radiofrequency cingulotomy. Patients with intractable abdominal or pelvic visceral pain can benefit from midline myelotomy. A careful patient selection is critical for the success of these procedures. An integrative team consisting of palliative care specialists, pain specialists and a neurosurgeon focused on this task provides a platform to optimize patients' selection. We will present our experience from the interdisciplinary evaluation of cancer patients undergoing neurosurgical interventions for intractable pain. We will review the clinical considerations guiding the choice of the therapeutic approach through representative clinical cases. This concurrent session will provide a review of ablative neurosurgical interventions; the current evidence for their use, their benefits, and risks. Through comprehensive case presentations and analysis, we will discuss patient selection considerations, patient safety and personal preferences guiding the assignment of each procedure to a specific patient.